Abstract

ORTIZ MARTINEZ, Karina et al. Stress cardiomyopathy with extracorporeal oxygenation membrane V-A during the puerperium. Case report and literature review. Med. crít. (Col. Mex. Med. Crít.) [online]. 2023, vol.37, n.2, pp.146-149.  Epub May 13, 2024. ISSN 2448-8909.  https://doi.org/10.35366/110451.

We present a case of a 28-year-old woman currently in her first pregnancy, normal evolution, who attended delivery care, a cesarean section was performed due to lack of progression. During the perioperative period, she developed uterine atony and bleeding of 2,000 mL, for which she underwent a subtotal abdominal hysterectomy, selective embolization of the pelvic vessels, massive transfusion, and pelvic packing. She evolved with vasoplegia and hemodynamic profile compatible with cardiogenic shock, transthoracic echocardiogram exposes severe systolic dysfunction, LVEF 18%, normal contractility in the basal thirds of the lateral wall, the rest of the segments with severe hypokinesia, NT-pro BNP 9,226 pg/mL, high-sensitivity troponin 490 pg/mL, electrocardiogram whit sinus tachycardia with no evidence of injury, the diagnosis of Takotsubo (stress cardiomyopathy) was established. Extracorporeal membrane oxygenation (ECMO) V-A and intra-aortic balloon counterpulsation were placed. Acute kidney injury developed, and fluid overload, for which renal replacement therapy was started. ECMO therapy was maintained for nine days, and she was discharged home after 18 days. ECMO is an innovative therapeutic strategy for hemodynamic support of cardiogenic shock, including stress cardiomyopathy, and this case illustrates its potential utility in the postpartum period.

Keywords : extracorporeal membrane oxygenation; Takotsubo cardiomyopathy; Intensive Care Unit; pregnancy; Takotsubo.